Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kentuckiana Oral & Maxillofacial Surgery Assoc PSC

Organization Dentist · NPI 1396737011

Kentuckiana Oral & Maxillofacial Surgery Assoc PSC is a Dentist in Louisville, Kentucky. Licensed in Kentucky. Registered with an NPI since 2005.

Licensed in
KY
In the registry since
2005
Specialties on file
3
What do these letters mean?
PSC — Professional service corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

2800 Cannons Ln Ste 200
Louisville, KY 40205
Phone: (502) 454-4885
Fax: (502) 452-1926
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Oral and Maxillofacial Surgery (Dentist) (primary) Taxonomy 1223S0112X (KY)
Dentist Taxonomy 122300000X (KY)
Oral & Maxillofacial Surgery (D.M.D.) Taxonomy 204E00000X (KY)

Record details

NPI number1396737011
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Nathan Walters — President · (502) 454-4885
NPI enumeratedAugust 18, 2005
Last updated in NPPESFebruary 6, 2018
Mailing address2800 Cannons Ln, Ste 200, Louisville, KY 40205

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